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Publication, Part of

Emergency Presentations of Cancer: Quarterly Data , Q4 2020/21 (Jan to March 2021)

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Things you need to know about this release


Things you need to know about this release

Background

Emergency presentation is an important predictor of cancer outcomes; patients with cancers that present as an emergency suffer significantly worse outcomes.

The 2015-2020 cancer strategy for England recommended that the proportion of emergency presentations should be regularly reported and reviewed. This metric estimates the proportion of emergency presentations using first admissions to hospital via emergency route (see emergency presentation section for definitions) as a proxy for emergency diagnosis. This method allows for more rapid reporting of this metric. The Rapid cancer registration dataset, which provides a quicker indicative source of cancer data compared to finalised cancer registrations, can also provide an alternative view on the data but is not a replacement to the full registration process that is used for all the National Statistics publications.


Points to consider when interpreting these statistics

The first COVID-19 lockdown began in England on 23 March 2020. Data from April to June 2020 are therefore likely to be influenced by the following potential factors:

  1. The number of new diagnoses will be affected by changes in patient behaviour, with fewer people thought to be reporting possible cancer symptoms to General Practitioners (GPs). Decreases were seen during the initial lockdown period in the numbers of General Practitioner  appointments and of people urgently referred for suspected cancer. With people encouraged to continue reporting worrying symptoms to their doctor, and doctors encouraged to refer patients as usual, the number of referrals increased after the initial lockdown although remained lower than usual for several months.
  2. The number of patients diagnosed with cancer is likely affected by additional pressures on imaging capacity or endoscopy due to increased use related to COVID-19 or reduced overall capacity resulting from additional infection control measures, for example, measures related to the potential aerosol generation from endoscopy procedures.
  3. For breast, colorectal and cervical cancers, the number of new cancer diagnoses will be affected by a reduction in screening activity, particularly during the initial peak of the COVID-19 pandemic and with the return to normal levels taking a varying amount of time across the country and by screening programme.

 

There are some cancers where emergency presentation may be the most appropriate route to diagnosis, for example, for children where the first symptom of underlying cancer is likely to result in an emergency presentation on the advice of their GP.

While a fall in emergency presentations may correlate with improved survival, this is not necessarily a direct cause and many other factors will be involved.

The indicator is not adjusted to take account of factors that could influence the health of patients in a geographical area. Geographical areas with an older population can expect to see a larger number of emergency presentations. Geographical areas with a larger number of lung cancers (due to smoking prevalence) or smaller number of breast cancers (due to broader socio-economic factors) can also expect to see a larger proportion of emergency presentations.

The number of cancer patients reported in each quarterly set of emergency presentation results can change over time, due to additional cancer registration information becoming available. As such, the historical quarterly proportions reported may also be subject to small changes.

Smaller populations will have more variability in their estimates than areas with larger populations and will therefore have larger confidence intervals.


Definitions and methods

HES

Hospital episode statistics (HES) is a database of details for: all hospital admissions (known as Admitted Patient Care), Accident and Emergency (A&E) attendances and outpatient appointments at NHS hospitals in England. In this bulletin only the Admitted Patient Care dataset is used to determine first presentations.

Emergency presentation

In this bulletin, an emergency presentation for cancer is defined as a first inpatient admission where the diagnostic code indicates a presentation of cancer, and where there is an emergency method of admission identified from Admitted Patient Care (HES).

A first presentation is considered an emergency if the method of admission is either:

  • Emergency: via Accident and Emergency (A&E)
  • Emergency: via general practitioner
  • Emergency: via Bed Bureau (this is emergency occurring while an inpatient (excluding A&E) for another reason)
  • Emergency: via other means including A&E department of another trust.

 

‘Emergency: via consultant outpatient clinic’ is not considered an emergency presentation. This is because the patient was already within a secondary care setting when referred to the inpatient appointment and therefore the patient’s entry into secondary care is unlikely to be an emergency.

First inpatient admissions for cancer

The denominator is the number of first inpatient admissions having a primary diagnostic code indicating a presentation of cancer identified from Admitted Patient Care (HES). The diagnosis codes in HES may not always include references to cancer for care that is not thought to be related to a cancer diagnosis at the time it was given. This means the metric may not include all tumours registered in the National Cancer Registration Dataset and the results presented here may differ from publicly available results such as Routes to Diagnosis. For full details of the methodology, please refer to the specifications of the Emergency Presentations metric.

Crude proportion

The number of first inpatient admissions for cancer presenting as an emergency, divided by, the total number of first inpatient admissions for cancer, multiplied by 100.

Confidence Intervals

Wilson score method is used to give 95% confidence intervals for all the proportions presented.

Statistical tests

The likelihood ratio test and two-sided proportions Z-test were used to test whether counts or proportions, respectively, were different from each other. A p-value of 0.05 was used to determine if the test was statistically significant.

1-year rolling proportion

The 1-year rolling proportion for a stated quarter includes the previous 3 quarters’ worth of data meaning a full 12 months of data is used. The denominator is then the total number of cancer presentations for those 4 quarters and the numerator is the total emergency presentations for those 4 quarters.


Further information

Other information related to this release are available:

 

Other statistics on cancer are available:

 

For queries relating to this bulletin contact ndrsenquiries@nhs.net



Last edited: 8 December 2021 12:32 pm